1. Perspectives and insights into how
evidence and knowledge can inform
large scale change in health care
Alison Turner
June 2016
@ali_pals
@Strategy_Unit
2. 2
The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Purpose of presentation
To share with you the findings of a
small study exploring the use of
evidence and knowledge in large
scale change
To reflect on the implications for
library and information
professionals
Bud Ellison CC BY 2.0
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The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Acknowledgements
Funded by:
Health Education West Midlands, Research Fellows programme
With thanks to:
New Care Models programme, NHS England
New Care Model vanguard sites
Dr Robin Bell, Dr Lynn Nichol, Prof Eleanor Bradley, University of Worcester
Midlands and Lancashire Commissioning Support Unit
Colleagues on the Research Fellows programme
Ashashyou CC BY 3.0
https://commons.wikimedia.org/wiki/File:Thank-you-word-cloud.jpg
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The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Why is this important?
The health service in England:
• is under increasing financial pressure
• is experiencing rising demand for healthcare
Solutions are needed to address these issues which involve transforming health and
social care:
• There is a growing recognition of the inherent complexity of healthcare transformation
• Transformation programmes are required to demonstrate a clear evidence base for change
BUT…
we know use of evidence is variable and inconsistent
SO….
we need a better understanding of how evidence is perceived and used
6. 6
The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Research questions
What
constitutes
evidence in the
context of large
scale change
in health care?
Which
evidence is
deemed to be
of value?
What
difference does
evidence
make?
How is
evidence
framed to
support
decisions?
What are the
barriers to
using
evidence?
Perspectives Processes
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The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Approach
Methodology:
Qualitative case study
Setting:
A national (England) programme to
develop and deliver new care models
Methods:
• Purposive sample of sites and
individuals (national and local level)
• Semi-structured interviews
• Document analysis
• Literature review
Analysis:
Framework analysis
Prepare
July -
September
Collect
October -
February
Analyse
December -
March
Share
April -
Design
May - JunePlan
Adapted from: Yin, R. K. (2014) Case study research: design and
methods. London: Sage.
9. 9
The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Perspectives
• Broad interpretations of what constitutes
evidence
• A need to integrate multiple sources and
types of evidence, to consider evidence “in
its totality"
• “Variance in value” with preferences
towards practice-based and patient-
generated evidence
• Context is important to help understand
how evidence may apply locally
“I suppose it’s possibly information that helps
support implementation of interventions to
show a good or bad, positive or negative
impact on a person, an individual or a
society.”
“You can vary this, you absolutely can’t vary
that because if you vary that it loses the
essence of what it was. And those are the kind
of tools I think people would find genuinely
useful, kind of assessment tools to allow them
to make an assessment of it”
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The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Processes
• Evidence typically used in earlier phases to
inform case for change and design
• Experiences of “information poverty” and
“information overload”
• Knowledge sharing across sites considered
important to “fail fast, learn fast”
• Time pressures suggested a “satisficing”
strategy (stopping when they feel the
information is “good enough“)
• Barriers at different levels:
• Evidence: e.g. hard to use
• Individual: e.g. skills/confidence
• Organisational: e.g. capacity
• National programme: e.g. support
not aligned with delivery
• Wider system: e.g. fragmented
support
“I suppose we didn’t go off and do formal
horizon scans and PICO [an approach to
devising a literature search strategy] things
and search for trials, we had a lot of the
information already there because this is
work that’s been built on.”
“I see my role as a clinical leader, to get on
and do what is blindingly obvious and I really
don’t want to spend a lot of my actual
personal time, or that of my team, building up
the evidence base which is out there anyway.
Somebody else can do that and put it in a
nice pack if they wish but I really need to just
get on and do what I need to do“
12. 12
The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
General conclusions
• Evidence is important particularly for informing design, building consensus and challenging
assumptions
• Whilst evidence is used to support the design of large scale change, there is little to suggest
this is sustained through the lifecycle of the programme
• Iterative change advocated by systems thinking is changing users’ requirements (demand
side) but the way we all work has yet to catch up!
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The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
Opportunities to improve evidence use
• Helping decision makers to apply evidence
locally by being more explicit about the
context of research and evaluation studies
• Balancing rigour and timeliness by identifying
which questions warrant rapid review or in-
depth research
• Embedding evidence and knowledge
mobilisation throughout the life of a
programme, aligning with formative
evaluation, through pragmatic products such
as “living reviews” and “evidence maps”
• Researchers and practitioners working
together to prioritise research questions
using methods which support iterative
change
• More collaboration in evidence support to
reduce duplication
“I think it’s the timeliness – it’s a key issue,
because for me I’d rather have something that
was 90% accurate quickly than 100%
accurate in 6 months time because the pace
at which we are expected to work doesn’t
allow for that, if that makes sense.”
15. 15
The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
An extended role for information professionals?
Moving beyond a “support service” towards an
embedded role?
• Design
• Implementation – iterative experimentation
• Evaluation
Skills we can bring:
• Complex searching
• Qualitative synthesis
• Knowledge mobilisation
• Knowledge management
Are you involved in supporting large scale
change/transformation of health and care
services?
• Please get in touch
NHS Change Model
http://www.nhsiq.nhs.uk/capacity-capability/change-model.aspx
17. 17
The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
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The Strategy Unit
Midlands and Lancashire CSU
www.midlandsandlancashirecsu.nhs.uk
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